title: Reducing readmissions after robotic surgical management of endometrial cancer: a potential for improved quality care.
abstract: OBJECTIVE
  To describe readmission patterns after robotic surgery for endometrial cancer and identify risk factors for readmission within 90 days of discharge.
  
  
  METHODS
  Patients with endometrial cancer who underwent robotic surgical management at an academic institution from 2006 to 2010 were identified. Patient characteristics, intraoperative data, and postoperative complications were analyzed. Student's t-test and Fisher's exact test were used to compare patients readmitted within 90 days to those who were not.
  
  
  RESULTS
  Three hundred ninety-five patients were included. Thirty (7.6%) were readmitted within 90 days of surgical discharge. Length of stay greater than one day (40.0% vs. 23.0%, p=0.04) and postoperative complication (63.3% vs. 13.4%, p<0.01) were associated with readmission. The median interval to readmission was 9.5 days and median duration of subsequent hospitalization was 2.5 days. Fever (31.3%) and workup for vaginal drainage (25.0%) were the most common reasons for readmission. Only 2 of the 10 patients readmitted with fever had culture-proven infection, and no patients readmitted for vaginal drainage had a confirmed urinary tract injury. Of the 30 patients readmitted, 5 required a second operation - 3 for vaginal cuff dehiscence and 2 for port site hernia.
  
  
  CONCLUSIONS
  Robotic surgery for endometrial cancer was associated with a 7.6% readmission rate. The most common reasons for readmission, fever and evaluation for urinary tract injury, were frequently not associated with severe illness. This supports additional education to consider raising the threshold for readmission by using more widespread outpatient evaluation for the potential complications of robotic endometrial cancer surgery.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA.
authors.forename: Margaret I
authors.initials: MI
authors.lastname: Liang
authors.forename: Maggie A
authors.initials: MA
authors.lastname: Rosen
authors.forename: Kellie S
authors.initials: KS
authors.lastname: Rath
authors.forename: Aine E
authors.initials: AE
authors.lastname: Clements
authors.forename: Floor J
authors.initials: FJ
authors.lastname: Backes
authors.forename: Eric L
authors.initials: EL
authors.lastname: Eisenhauer
authors.forename: Ritu
authors.initials: R
authors.lastname: Salani
authors.forename: David M
authors.initials: DM
authors.lastname: O'Malley
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Fowler
authors.forename: David E
authors.initials: DE
authors.lastname: Cohn
mesh_terms: D000328:Adult; D000368:Aged; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005334:Fever / Q000209:etiology / Q000628:therapy; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D009367:Neoplasm Staging; D010052:Ovariectomy / Q000009:adverse effects* / Q000379:methods; D010359:Patient Readmission / Q000706:statistics & numerical data; D012371:Robotics / Q000379:methods / Q000706:statistics & numerical data*; D014551:Urinary Tract / Q000293:injuries
keywords: Endometrial cancer; Hospital readmission; Robotic surgery